Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 9-year-old child was admitted to the hospital with congenital left ureteropelvic junction obstruction with massive left pyelocaliectasis and underwent dismembered pyeloplasty of the left kidney under general anesthesia without complications. Postoperatively, the child was placed on patient-controlled analgesia, with morphine as the drug of choice. The patient was discharged to the ward with adequate pain control and no complaints of nausea or vomiting. Once on the ward, a transdermal scopolamine patch was placed for nausea and vomiting. More than 24 hours after patch placement, the child experienced central anticholinergic syndrome (CAS) with hallucinations and incontinence. The scopolamine patch was promptly removed, and all symptoms of CAS rapidly ceased. A transdermal scopolamine patch should not be used in the pediatric population, and with extreme caution in the elderly. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and possible physostigmine administration.
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PMID:Central anticholinergic syndrome in a pediatric patient following transdermal scopolamine patch placement. 144 54

Urinary retention, overflow incontinence, and subsequent detrusor atony were observed following surgery in which a morphine with bupivacaine epidural injection was used for perioperative analgesia. The premise that the urinary retention may have been due to the effects of the morphine component of the epidural is discussed, along with other possible causes.
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PMID:Postoperative urinary retention in a dog following morphine with bupivacaine epidural analgesia. 978 79

Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anaesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthetic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).
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PMID:[Indications for central versus peripheral regional anesthesia]. 1092 50

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. The problem with spinal epidural abscesses is not treatment, but early diagnosis - before massive neurological symptoms occur" (Strohecker and Grobovschek 1986).
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PMID:Spinal epidural abscess: a meta-analysis of 915 patients. 1115 48

The purpose of the present study was to determine the value of circular hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) on the basis of data collected prospectively during the initial experience of a group of Latin American surgeons. Between 2000 and 2001, PPH was performed using a circular stapler in 177 patients who had third- and fourth-degree hemorrhoidal disease. The average age of the patients was 47.7 years (range 26 to 85 years). Anal bleeding was the most common preoperative complaint (93.2%) followed by anal pain (60.2%), anal itching (43%), and constipation (41%). Hemorrhoids were classified as third degree in 132 patients (74%) and fourth degree in 45 patients (25.4%). Skin tags were detected in 86 patients (48.8%) and rectocele in 14 patients (7.9%). Data collected included patient demographics, type of anesthesia, and specific details of the surgery such as duration of the operation, distance from the staple line to the dentate line, need for complementary hemostasis, and any unexpected occurrences. Postoperative data collected included the degree of pain, which was evaluated on the basis of the type and dosage of analgesics required, laxative consumption, and the presence of bleeding, fever, urinary retention, or hematomas. Each patient completed a written questionnaire addressing these events. Patients returned for follow-up visits on days 7, 15, 30, and 90. Responses to pain, bleeding, fever, anal continence, recurrence of hemorrhoids, and level of satisfaction were compiled. The duration of the procedure ranged from 6 minutes to 2 hours (average 23 minutes), and most operations lasted no more than 20 minutes, with the exception of one that lasted 2 hours because of intraoperative bleeding. Intraoperative problems were minor. An additional one or a few sutures were required in 58.7% of patients to achieve perfect hemostasis. In 128 patients (72.3%) the hospital stay was less than 24 hours. Same-day surgery was chosen for 37 patients (20.9%). Pain was controlled with analgesia only using one to six doses of oral dipirona in 126 patients. Five patients were readmitted to the hospital: four for control of bleeding and one for conventional hemorrhoidectomy due to an acute episode of external hemorrhoidal thrombosis. At day 30, patients rated the efficacy of the procedure in alleviating preoperative symptoms as follows: 77.5% excellent; 16% good; 5.3% average, and 1.2% poor. At 3 months postoperatively no patient had had a recurrence of hemorrhoidal prolapse, and there were no instances of stenosis or anal incontinence. Surgeons also rated the efficacy of the procedure as excellent in 75%, good in 19.8%, average in 4.7%, and poor in 0.6%. With proper selection of patients and adequate stapling technique, stapled hemorrhoidectomy may be considered safe; it is easily learned, has a satisfactory degree of pain, and is well accepted by both patients and surgeons.
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PMID:Stapled hemorrhoidectomy: initial experience of a Latin American group. 1312 62

The purpose of this study was to evaluate the feasibility, safety and efficacy of performing the Burch urethropexy (BU) and the abdominal paravaginal repair (APR) through a 1.5-2.5 in suprapubic incision. A prospective clinical study was undertaken by four urogynecologists. Seventy-three patients, each with a urodynamic and clinical diagnosis of genuine stress incontinence, underwent a BU procedure, with 33 of the 73 having concomitant APR through the same incision. The duration of surgery and any complications were recorded. Postoperative outcome tests included subjective incontinence questionnaire, cough stress testing, pad testing, measurement of residual volumes, and analgesia requirements. The BU procedure was accomplished in 72 of 73 patients, with 1 requiring conversion to a 5 in incision. The mean operative time was 64.6 +/-21.9 (SD) min. Intraoperatively, 1 patient was noted to have a suture in the bladder. All patient having only a BU (40) went home on the day of surgery or the first postoperative day, and all patients with BU and APR went home within 2 days. All but 1 patient met the criteria for catheter removal within 7 days, with 1 patient suffering obstructive voiding. At a mean follow-up of 9 months, cough stress test and questionnaire demonstrated complete cure in 70 of 72 patients tested. Pad testing confirmed cure in all of the 46 patients who consented to the test. We conclude that the standard Burch procedure and paravaginal repair can be accomplished safely and with excellent short-term efficacy through a 1.5-2.5 in incision.
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PMID:Mini-incisional Burch urethropexy: a less invasive method to accomplish a time-tested procedure for treatment of genuine stress incontinence. 1475 94

BACKGROUND: This study was carried out to identify risk factors associated with urinary incontinence in women three months after giving birth. METHODS: Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence. This prospective cohort study in 949 pregnant women in Quebec, Canada was nested within a randomised controlled trial of prenatal perineal massage. RESULTS: Postpartum urinary incontinence was increased with prepregnancy incontinence (adjusted odds ratio [adj0R] 6.44, 95% CI 4.15, 9.98), incontinence beginning during pregnancy (adjOR 1.93, 95% CI 1.32, 2.83), and higher prepregnancy body mass index (adjOR 1.07/unit of BMI, 95% CI 1.03,1.11). Caesarean section was highly protective (adjOR 0.27, 95% CI 0.14, 0.50). While there was a trend towards increasing incontinence with forceps delivery (adjOR 1.73, 95% CI 0.96, 3.13) this was not statistically significant. The weight of the baby, episiotomy, the length of the second stage of labour, and epidural analgesia were not predictive of urinary incontinence. Nor was prenatal perineal massage, the randomised controlled trial intervention. When the analysis was limited to women having their first vaginal birth, the same risk factors were important, with similar adjusted odds ratios. CONCLUSIONS: Urinary incontinence during pregnancy is extremely common, affecting over half of pregnant women. Urinary incontinence beginning during pregnancy roughly doubles the likelihood of urinary incontinence at 3 months postpartum, regardless whether delivery is vaginal or by Caesarean section.
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PMID:Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study. 1505 37

An epidural abscess, defined as a collection of pus between the dura mater of the spinal cord and the vertebral canal (Mosby, 2002), is a rare complication of epidural analgesia. Prompt diagnosis and treatment are essential to a good outcome. If left untreated, an epidural abscess can result in permanent paralysis and incontinence. It is essential that nurses caring for patients receiving epidural analgesia are aware of this potential risk.
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PMID:Ensuring prompt diagnosis and treatment of epidural abscess. 1591 60

Total rectal prolapse is a disabling disease. The aim of this study was to evaluate pain management, hospital stays, constipation, and continence status among military personnel who underwent laparoscopic surgery. Forty patients (mostly men) underwent laparoscopic rectopexy (LR) or laparoscopic resection rectopexy (LRR). Colonic transit time, postoperative pain scores, preoperative and postoperative anal function, and changes in constipation were assessed. The median operation times for LR and LRR were 126 and 223 minutes, respectively. The median postoperative hospital stays were 3 and approximately 6 days for LR and LRR, respectively. Patients needed fewer analgesics in a short postoperative period. However, there was no difference between the two groups in analgesic requirements. Continence improved for approximately 71% of patients, but constipation was treated for 50% of affected patients. No recurrences were noted in the follow-up periods, which were 13 and 22 months for the LRR and LR groups, respectively. The quality of life for the patients who underwent LR was not as good as that for the patients who underwent LRR, at the end of 1 year. We eliminated total rectal prolapse and almost cured incontinence by using laparoscopy, although the disadvantageous aspects were long operation times and suboptimal healing with respect to constipation and related symptoms. LRR is the more feasible procedure, with the emphasis on elimination of incontinence and constipation, producing a better quality of life for patients, in addition to short hospitalizations, necessity for analgesia for a short time, and return to hard training field activities in a short time among military personnel.
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PMID:The impact of laparoscopic resection rectopexy in patients with total rectal prolapse. 1626 77

The aim of the study was to search for objective criteria witch might help us to make a choice between obstetrical forceps and vacuum extractor in front of such a clinical situation. In that purpose, we realised a medline research to compare those two obstetrical instruments in term of advantages, disadvantages and specific complications. Vacuum extractor is the most used in the industrialized countries, learning seems to be quickest, time from decision to extraction a little bit longer than with forceps (Level II-2). Vacuum extractor is recommended in case of low presentation with transversal or posterior variety (Level III) or when no analgesia is available (Level III). Forceps are more successful than vacuum (Level II-1), are recommended in case of prematurity and complete anesthesia (Level III). Immediate maternal complications (cervical tear, vaginal and perineal laceration, use of episiotomy) are less frequent with vacuum extractor (Level II-1). Long term effects on the pelvic floor and the bladder continence are comparable with natural delivery for both forceps and vacuum (Level II-1) but anal incontinence is increased, especially with forceps (Level II-1). Benign immediate neonatal morbidity is comparable for both instruments, but there are some specific complications (Level II-1). Thus, cephalhaematomas and potentially dramatic extensive subgaleal haematomas (even rare), retinal haemorrhage are more frequent with the use of vacuum extractor (Level II-1). Facial nerve paralysis, skull fracture (even rare) are more frequent with forceps (Level II-2). Neonatal convulsions frequency is comparable with both instruments (Level II-2), such are middle and long term complications (Level II-3). Finally, failure of forceps extraction needs a caesarean section but there is no clear evidence in the literature for the sequential use of forceps after failure of vacuum (Level III).
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PMID:[Comparison vacuum extractor versus forceps]. 1926


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